1. Blood Components and Plasma derivatives

2. The anticoagulants and preservatives that are added to blood nowadays enable storage for long periods of time
Before acid-citrate-dextrose (ACD) was used- 21 days
Aseptic separation of blood into cellular & plasma components by the introduction of plastic collection systems
Before glass bottles were used

3. Blood collection
Blood is collected in plastic bag systems with anticoagulant & preservative
Whole blood can be stored at 4oC for up to 5 weeks
Whole blood contains many components
Wasteful to give whole blood if only red cells are needed

4. Blood Components
Human blood consists of plasma, in which cells are suspended
The plasma also contains other specialised substances, which are important for blood clot formation (e.g. clotting factors)
Whole blood can be separated at the blood bank into various components

5. BLOOD COMPONENTS Blood separated into different parts:
Packed red cells
Platelets
Fresh frozen plasma
Cryoprecipitate
Granulocytes
Factor IX conc.
Factor VIII conc.
There are more than 20 different products available

6. (Fresh) frozen plasma (FFP)
Whole blood
Red cells
Granulocytes
Plasma
Platelets
(Fresh) frozen plasma (FFP)
Fractionated products
Immuno-
globulins
F Vlla
Cryoprecipitate
Stored Plasma
F Vlll
Albumin
F lX

7. Whole Blood One unit contains 450 ml of blood
& 63 ml of anticoagulant-preservative

8. RBC Anticoagulant/Preservative Solutions
Purpose of RBC Preservation
Designed to prevent clotting and maintain red cell viability and function during storage.
Usual anticoagulant-preservative is CPD-A (Citrate Phosphate Dextrose Adenine )
Anticoagulant-Preservative Contents
Citrate: anticoagulant (binds plasma calcium and prevent activation of coagulation cascade)
Phosphate: provide substrate to help maintain red cell 2,3 DPG levels
Dextrose: a sugar, provides substrate for ATP production.
Adenine: Acts as a substrate for RBC synthesis of ATP
It binds with greater affinity to deoxygenated hemoglobin (e.g. when the red cell is near respiring tissue) than it does to oxygenated hemoglobin (e.g. in the lungs). In bonding to partially deoxygenated hemoglobin it allosterically upregulates the release of the remaining oxygen molecules bound to the hemoglobin, thus enhancing the ability of RBCs to release oxygen near tissues that need it most.

9. During storage at 4oC Platelets and WBCs Red cells Plasma
become nonfunctional during hours of collection
Red cells
5 weeks in CPD-A have a mean recovery 70%
Plasma
 K+,  H+ →  pH
Levels of coagulation factors V & VIII decrease

10. Blood Components
Refers to a product separated from a single unit of whole blood
The term plasma derivative indicates a blood product separated from a large volume of pooled plasma by a process called fractionation

11. Blood components Plasma Derivatives Oxygen carrying components
Red cell concentrates (RCC)
Leukocyte poor blood
Frozen-thawed red cells
Platelet products
Platelet rich plasma (PRP)
Platelet concentrates (PC)
Plasma products
Fresh frozen plasma (FFP)
Frozen plasma (FP)
Cryoprecipitate
Stored plasma
Plasma Derivatives
Coagulation Factor concentrates
Factor VIII concentrates
Factor IX complex concentrates & others
Oncotic agents
Albumin
Plasma protein fraction (PPF)
Immune serum Globulin
Hepatitis B Ig (HBIG)
Varicella-zoster Ig (VZIG)
Rh Ig (RhIG)
Tetanus Ig (TIG)

12. A- Blood components that carry oxygen
Increase the oxygen carrying capacity of the blood by increasing the circulating red blood cell mass.
Carry oxygen and nourishment to the tissues and take away carbon dioxide.

13. 1- Red blood cell concentrates
Prepared by removing approx. 200 ml of plasma from whole blood after centrifugation
RBCs plus 100 ml of residual palsma
In CPD-A can be stored for 35 days at 4oC

14. 1- Red blood cell concentrates
Whole Blood
Red cell concentrate
Total Volume
500 ml
300 ml
Volume of red cells
200 ml
Volume of plasma
100 ml
Hematocrit
40 %
70 %

15. 1- Red blood cell concentrates
High hematocrit → viscous → infuse slowly
Rate of infusion increased by adding saline
Other fluids should not used
Calcium containg fluids (eg. Ringer’s lactate) should not be added
May cause clotting
Glucose solutions
can cause clumping
Only saline can be added to blood

16. 2- Leukocyte poor blood No viable leukocytes
WBCs are of no consequence
In some patients cause febrile transfusion reaction
Should receive leukocytes poor-blood
WBCs can be removed by discarding the buffy coat (inverted centrifugation)
Or by washing RBCs or by using filters
Buffy coat
Red cells

17. 3- Frozen-thawed red cells
Red cells can be frozen with use of cryopreservation techniques
Permit storage for up to 10 years
Expensive procedure & recommended only in special circumstances
e.g. Individuals with rare blood types
For auto-transfusion

18. 3- Frozen-thawed red cells
The RBC's are first incubated in a 40% glycerol solution which acts as an "antifreeze" within the cells.
The units are then placed in special sterile containers in a deep freezer at less than degrees C.
Cryopreserved units are thawed and washed free of glycerol prior to use as saline suspended RBC's.

19. 4- Synthetic oxygen carrying agents
Perfluorochemical (e.g. Fluosol-DA )
Fluorinated hydrocarbons
Readily dissolve oxygen
Poor soluble in plasma
Side effects:
Hypotension
DIC
Chemically modified hemoglobin
Free Hb has a very short half life
Chemically modified to:
increase intravascular survival
and to make it more effective in carrying oxygen

20. B- Platelet Products Platelet Rich Plasma (PRP) Platelet Concentrates
Gentle centrifugation of whole blood
Supernatant transferred to the 2nd bag
Platelet Concentrates
Prepared from PRP by a 2nd centrifugation
Removal of all but 50 ml of plasma
Contain approx. 6X1010 platelets
60 – 80% Plts present in whole blood unit
Remain 5 days
Longer at 22oC with continuous agitation

21. B- Platelet Products Contamination by WBCs & RBCs is usually small
But there is enough to induce alloimmunization
Plt concentrates from Rh +ve should not be administered to Rh –ve women
Storage at 22oC, therefore care to prevent contamination

22. C- Plasma Products
Plt poor plasma can be separated into a number of products
Fresh frozen plasma
Frozen plasma
Cryoprecipitate
Stored plasma

23. 1- Fresh frozen plasma (FFP)
Prepared from whole blood within 6 hours of collection
Rapid freezing of plasma preserves the labile coagulation factors at maximum levels
Donot contain cellular elements
200 ml volume
Stored at -30oC for 12 months

24. 2- Frozen Plasma (FP)
Separated from whole blood within 24 hours of collection
Contains at least 50 % of original factor VIII & factor V frozen plasma
Adequate source for treatment of mild to moderate coagulation factor deficiencies
200 ml volume
Storage at -30oC for up to 12 months

25. 3- Cryoprecipitate
Produced from freshly separated plasma by freezing at -70oC followed by thawing at 4oC
Flocculent precipitate is rich in factor VIII, fibrinogen and fibronectin
Once thawed, mixture is centrifuged to sediment the cryoprecipitate & all but 5 to 10 ml of supernatant plasma is removed
Contains 250 mg fibrinogen
80 clotting units of factor VIII
Stored at -30oC for 12 months
Fibronectin plays a major role in cell adhesion, growth, migration and differentiation, and it is important for processes such as wound healing and embryonic development.[1] Altered fibronectin expression, degradation, and organization has been associated with a number of pathologies, including cancer and fibrosis

26. 3- Cryoprecipitate
Increase of 2% of factor VIII level for each bag of cryoprecipitate infused
Supernatant plasma removed is called stored plasma
Must be used within 5 weeks if stored at 4oC
Lasts for 2 years at -30oC

27. 4- Stored plasma
Plasma separated from whole blood after 24 hours of storage at 4oC
Can also be derived from cryoprecipitate production
Contain reduced levels of labile coagulation factors V VIII & fibrinogen
It is indicated for patients requiring volume expansion or protein replacement when labile clotting factors are not required
Plasma products do not require crossmatch prior to use but should be ABO compatible

28. Plasma Derivatives

29. Certain plasma derivatives can be obtained by fractionating the fresh frozen plasma or stored plasma
Fractionation:
Allows the processing of large volumes of pooled plasma
Pooling of many units increases the risk of viral transmission to the recipient

30. Plasma protein fractionation
Plasma proteins are separated according to differences of each protein.
Fractionation involves changing the conditions of the pooled plasma (e.g. the temperature or the acidity)
Proteins that are normally dissolved in the plasma fluid become insoluble, forming large clumps, called precipitate.
The insoluble protein can be collected by centrifugation.

31. One of the very effective ways for carrying out this process is the addition of alcohol to the plasma pool while simultaneously cooling the pool.
This process is sometimes called cold alcohol fractionation or ethanol fractionation.
This procedure is carried out in a series of steps so that a single pool of plasma yields several different protein products, such as albumin and immune globulin.

32. Preparation avaliable
Plasma Derivatives
Plasma Derivatives
Preparation avaliable
Coagulation Factors
Factor VIII concentrates
Factor IX concentrates
Anti-thrombin III
Albumin
Plasma protein fraction
Immune globulins
Non-specific immune serum globulin (ISG)
Rh immune globulin (RhIG)
Hepatitis B immune globulin (HBIG)
Varicella-Zoster immune globulin (VZIG)
Tetanus immune globulin (TIG)

33. 1- Coagulation Factor Concentrates
Prepared in a freeze-dried form
Indicated for patients with congenital coagulation deficiencies
Risk of hepatitis is high
Should not used for mild acquired coagulation deficiencies
Should be treated with FP or FFP

34. Factor VIII Concentrate
Commercially prepared, lyophilized powder purified from human FFP
Contain also small amounts of fibrinogen & other proteins
Can contain blood group Abs
Treat patients with hemophilia A

35. Differences of Cryoprecipitate & Factor VIII concentrates
Storage Temp.
-30oC
4oC
Short period RT
Risk of Hepatitis
Low
High
Treatment of hemophilia A
Yes
Treatment of vW disease no

36. Factor IX Concentrate
For the treatment Factor IX deficiency or Hemophilia B (Christmas Disease).
Have been used to treat patients with acquired inhibitors of factor VIII
Have factor VIII bypassing activity
Contains also factors II, VII & X in concentrated form
Vials containing 500 units of factor IX

37. Factor IX Concentrate & liver disease
It is contraindicated in patients with liver disease
Have low levels of circulating antithrombin III
Activation of clotting factors present in some factor IX concentrates,
cause DIC

38. Blood products & treatment of specific clotting factor deficiencies
Deficiency
Blood product Indicated
Fibrinogen
Cryoprecipitate
Stored plasma
Factor V
Fresh frozen plasma
Frozen plasma
Factor VII
Factor IX concentrate
Factor VIII
Factor VIII concentrate
Von Willebrand’s Disease
Factor IX
Factor X
Factor XI
Factor XIII

39. 2- Oncotic Agents Albumin: volume expansion
Other colloids are available for blood volume expansion
Dextran
Gelatin
Hydroxyethyl starch
Polyvinylpyrrolidone

40. Albumin Albumin is prepared by ethanol fractionation of pooled plasma
Available in 5% and 25% concentrations.
Have physiological sodium content
No risk of hepatitis, sterilized during preparation
No coagulation factors or blood group Abs

41. Albumin
Used for treatment of hypovolaemia and hypoalbuminaemia (result from abnormal synthesis, increased metabolism or loss)
It maintains capillary osmotic pressure
Carrier protein for drugs, hormones, enzymes & metabolites

42. Plasma protein Fraction
Partially purified albumin
Contains ≈ 85% albumin & 15% other plasma proteins

43. 3- Immune Globulins
Contains immune IgG antibodies, prepared from pools of plasma.
For disease prophylaxis, hepatitis A, measles, varicella and rubella.
For the treatment of hypogammaglobulin-emia and agammaglobulinemia.
Measles الحصبة
Varicellaجدري الماء
Rubellaالحصبة الالمانية

44. Immune Serum Globulin (ISG)
Primarily IgG Ab
Prevention of some viral diseases
Hypogammaglobulinemia
Congenital immune deficiency
Given by IM injection (aggregates of IgG)

45. Hepatitis B Immune Globulin (HBIG)
Contains Hepatitis B immune antibodies.
From plasma of donors with high titer of Ab to HBsAg
Provides passive immunization for HBV.
For treatment after exposure to HBsAg.
For the prevention of maternally transferred HBV (perinatal exposure).

46. Varicella-Zoster immune globulin (VZIG)
Derived from patients had recent Herpes Zoster infections
Herpes Zoster infections result in severe fatal infection in immunocompromised individuals
Passive administration of VZIG during 72 hours of exposure can prevent or attenuate infection

47. Rh Immune Globulin (RhIG)
Derived from Rh -ve individuals
Contains IgG antibodies to the D antigen on red blood cells.
Given during pregnancy and post-natally to Rh negative mothers to prevent the development of anti-D and hemolytic disease of the newborn (HDN) due to anti-D.
Given prophylacticaly following abortion, or invasive maternal procedures (e.g., amniocentesis).

48. Tetanus Immune Globulin (TIG)
Prepared from individuals specifically immunized for tetanus toxoid
Available for individuals at risk following injury